Emotions in Medical Decision Making in Older Adults

描述（由申请人提供）：医疗决策研究利用经济学和统计学的见解来建立临床决策的定量模型。这些模型依赖于决策者使用信息的假设，包括人们以狭隘的逻辑方式处理信息的核心假设。最近，决策者的心理，包括他们的情绪状态，正在被纳入这些模型，以增强认知的作用。对老年人的研究在许多方面与其他人群有很大的不同，这可能会影响医疗决策，尤其是情绪的作用。从他的博士论文开始，威廉·戴尔博士将加强他在老年病学和公共政策方面的跨学科培训，重点是更深入地了解老年人医疗决策中的情绪。本研究议程首先利用前列腺癌的临床模型，前列腺癌是一种在老年男性中广泛流行的疾病，其中焦虑情绪可能影响决策。尽管对于检测和治疗前列腺癌的“正确”临床途径尚未达成共识，但人们普遍认为，患者的偏好对做出选择至关重要。初步调查表明，将焦虑纳入局限性前列腺癌患者的效用评估显著影响治疗的成本-效果比。进一步的研究评估焦虑对这些男性效用评估的贡献正在进行中。本研究作为理解情绪在老年人医疗决策中的作用这一整体职业目标的具体核心例子。老年人护理发生在复杂的社会-医学-心理环境中，需要对功能障碍、多种合并症、多种用药和照护者负担等问题的重要性保持敏感性。作为一名老年医学专家，戴尔博士在进行研究时对这些问题很敏感。在他的导师的专家指导下，通过对心理学和医疗决策的有针对性的深入理解，加强他在公共政策研究和老年病学方面的广泛培训，戴尔博士将为研究老年人医疗决策中情绪的作用建立必要的专业知识。

DESCRIPTION (provided by applicant): Research on medical decision-making makes use of insights from economics and statistics to build quantitative models of clinical decisions. These models rely on assumptions about the use of information by decision-makers, including the core assumption that people process information in a narrowly logical manner. Recently, the psychology of decision-makers, including their emotional states, is being incorporated into these models to augment the role of cognition. Research on older adults differs importantly from other populations in a number of ways that may impact medical decision-making, especially the role of emotions. Pursuing work begun with his dissertation, William Dale, MD, PhD, will enhance his interdisciplinary training in geriatrics and public policy by focusing on a deeper understanding of emotions in medical decision-making in older adults. This research agenda initially utilizes the clinical model of prostate cancer, a widely prevalent disease in older men, and one in which the role of the emotion of anxiety may influence decision-making. Although no consensus exists on the "right" clinical pathway for detecting and treating prostate cancer, there is wide agreement that patient preferences are vital for making choices. Initial investigations indicate the inclusion of anxiety in utility assessments for men with localized prostate cancer dramatically affect the cost-effectiveness ratios for treatments. Further research to assess the contribution of anxiety to utility assessments for these men is on-going. This study serves as a specific core example of the overall career goal of understanding the role of emotions in medical decision-making in older adults. Older adults care occurs in a complicated socio-medico-psychological context that demands sensitivity to the importance of issues such as functional impairments, multiple co-morbidities, polypharmacy, and care-giver burden. As a geriatrician, Dr. Dale is sensitive of including these concerns in pursuing his research. Enhancing his broad-based training in public policy studies and geriatrics with a targeted, in-depth understanding of psychology and medical decision-making under the expert guidance of his mentors, Dr. Dale will build the necessary expertise for a career researching the role of emotions in medical decisions for older adults.